Invited commentary

Invited commentary
Tolhurst, D.
1997-09-01 00:00:00
lix, transposition of the tail of the antihelix (Gault) and scoring of the cartilage at right angles to the antihelix in irregular or recalcitrant cases. In unilateral cases one D.E. Tolhurst usually need excise only a very narrow strip of skin. 47 Aylesford Street, London SWlV 3RY, UK The operation is not infallible and if recorrection is required it can be safely accomplished with the same ba- sic approach. Keloids are rare but it is worth trying exci- It was whilst I was doing a short locum at Mt. Vernon sion as they do not appear to behave as typical keloids in Hospital near London in 1966 that I learned Chongchet's the majority of cases that I have treated. operation from John Hanrahan who was then a registrar Finally, there seemed something vaguely familiar to me in the plastic surgery department. Chongchet, from Thai- in Figs. 1 and 2, and upon checking my photos of 24 land, when working in Bristol, had acquired the idea of years ago I found that Nebil Bozdo~an, who had once scoring the auricular cartilage a few years earlier and had the dubious privilege of being my resident, had tak- had perfected and published the technique in 1963. en them from my article. I would gladly have granted Much later I recall some unproductive discussion on the him the unfettered right of using them by way of extra subject of who was the real originator of the procedure. recompense for the generous gift of two excellent bicy- No one could remember how the idea reached Mt. Ver- cles (one of which was subsequently stolen) which he non nor could any publications on the technique antedat- gave me upon returning to Turkey, however I discovered ing Chongchet's be found. that without the permission of the British Journal of My own article on the subject did not endear me to Plastic Surgery he would be in breach of copyright. Like my senior colleagues at Mt. Vernon! I was for some the Chongchet operation, the remaining bicycle is still years aware of a coolness bordering on frigidity whenev- going strong. er I encountered these gentlemen and it was only when I attained a rank and position similar to theirs that I learnt that I should have left pontifications on the science of bat ear correction to more permanent members of the staff. However, a more pragmatic colleague commented Editor's comment that "If the chaps at Mt. Vernon hadn't been so idle they could have beaten you to the draw since they had seven years in which do to so." I decided to publish this paper not because it contains There were two reason for writing the article. The anything very new but because it gives some further first was to placate my boss who was forever enjoining publicity to the anterior scoring method of prominent ear me to publish something for the sake of my career and reconstruction. In the United States where prominent the second was to remind people of the simplicity, nay ears seem to be much less of a social problem than in the physiological beauty of Chongchet's operation for as Europe, the number of cases seen are few and many resi- the cartilage is scored one sees it cuff back to the desired dents will go through their training having seen consid- shape. It is astonishing that the operation is not univer- erably less than ten being operated on and may have sally used and even more surprising that it is almost ig- done very few corrections on their own. Certainly if one nored in the United States! contrasts this with the United Kingdom situation, where For more than 30 years I have found it both simple, prominent ears are probably the varicose veins of plastic rational and dependable, and free of the risk of compli- surgery and every resident is very experienced in their cations which can result from the burying of non-absorb- correction. able sutures. As Bozdo~an et al. point out it is effective Having worked in the center where Mr. Jack Mus- for both the excessively deep concha as well as the ab- tard6 developed his suture technique for correction of sent antihelix. There is no need for conchal excision or prominent ears, ! know that this is not always successful multiple incisions right through the cartilage, burring and there can be problems with the buried sutures such (often on the wrong side) or the use of complex sutures as infection and sinus formation. Strangely enough this of nylon or even wire! I have seen a fair number of pa- is a method used almost universally in the United States. tients who have been dissatisfied with the results follow- To me, the anterior scoring technique is logical, easy and ing "blind" scoring or scratching of the cartilage by vari- gives good permanent results. It is possible to do this in ous instruments introduced through small anterior skin different ways with slight changes in basic philosophy. It incisions. Cartilage irregularities or undercorrection are is for this reason that I have asked Mr. David Tolhurst to the main complaints. provide a commentary on this paper. A number of minor modifications exist including the I.T. Jackson use of Vicryl sutures to accentuate the fold of the antihe- (Editor-in-Chief)
http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.pngEuropean Journal of Plastic SurgerySpringer Journalshttp://www.deepdyve.com/lp/springer-journals/invited-commentary-RwU880dJNz